Healthcare Provider Details

I. General information

NPI: 1710302286
Provider Name (Legal Business Name): AFFILIATED COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7590 NW 186TH ST SUITE 208
HIALEAH FL
33015-2952
US

IV. Provider business mailing address

7590 NW 186TH ST SUITE 208
HIALEAH FL
33015-2952
US

V. Phone/Fax

Practice location:
  • Phone: 305-362-8326
  • Fax: 305-362-1244
Mailing address:
  • Phone: 305-362-8326
  • Fax: 305-362-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW1781
License Number StateFL

VIII. Authorized Official

Name: MARY MALDONADO-BERMUDEZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 305-362-8326